Scientist Led Exercise Stress Testing is Safe with the Equivalent Diagnostic Interpretation as a Cardiologist in Low to Intermediate Risk Patients

Abstract

Background: The implementation of non-physician led exercise stress testing (EST) has increased over the last 30 years, with endorsement by many cardiovascular societies around the world. The comparable safety of non-physician led EST to physician led studies has been demonstrated, with some studies also showing agreement in diagnostic preliminary interpretations. The study aim was to firstly confirm the safety of non-physician led EST in a large cohort and secondly compare the diagnostic accuracy of cardiac scientist and junior medical officer (JMO) led EST reports to cardiology consultant overreads. Methods: All ESTs performed between 1/7/2010 and 30/6/2013 were included in the study for JMO led tests (n = 1332). ESTs performed for the investigation of coronary artery disease between 1/7/2013 and 30/6/2016 were included for scientist led testing (n = 1904). Preliminary findings by the JMO and the senior cardiac scientist were compared to the cardiology consultant overread to establish diagnostic accuracy. Results: There was one adverse event, an ST segment myocardial infarction during the recovery phase of a JMO led EST. Disease prevalence was similar in the JMO and scientist led groups (p = 0.77). Sensitivity for JMO led tests differed from the cardiologist overread (86.96% vs 96.77%, p = 0.03). There were no other significant differences between the cardiologist overread and the JMO or scientist led interpretation. Conclusion: Scientist led EST is safe in low/intermediate risk patients and their preliminary reports are equally diagnostic as cardiologist overreads. While JMO led ESTs are just as safe, the preliminary reports differ significantly from cardiologist overread with respect to sensitivity.